Practica Oto-Rhino-Laryngologica

Effect on Otitis Media with Effusion of Middle Ear Inflation through Eustachian Tube

Haruo TAKAHASHI, Akihiko FUJITA

1994 Volume 87 Issue 6 Pages 735-740
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.735

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The significance of inflation of the middle ear through the eustachian tube on ears with otitis media with effusion (OME) was investigated from the aspects of middle ear ventilation and preservation of the patency of the eustachian tube.
1. Middle ear pressure was serially monitored in ten ears with OME by tympanometry after catheter inflation. From a positive deflexion just after the inflation, the middle ear pressure decreased rapidly to negative within ten minutes.
2. Conditions of the middle ear effusion of a patient with OME showed no remarkable change in magnetic resonance images recorded before and after three catheter inflations (every other day) of the middle ear.
3. On both of the two temporal bones obtained from two children with OME, a thick effusion rich in cellular elements was found filling the bony portion of their eustachian tubes.
4. The viscosity of middle ear effusion was significantly higher in the bony portion of the eustachian tube than in the hypotympanum.
5. The eustachian tube function of a patient with OME following upper respiratory infection is described. The eustachian tube was obstructed, but after catheter inflation through it, its functions rapidly became normal, and her OME was cured in one week.
The above observations indicate that inflation through the eustachian tube is more likely to exert its therapeutic effect by the preservation or the reestablishment of the patency of the eustachian tube than by ventilation of the middle ear.

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Piriform Sinus Fistula

[in Japanese], [in Japanese], [in Japanese]

1994 Volume 87 Issue 6 Pages 742-743
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.742

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Otitis Media with Effusion in 1951

Ryozo ASAI, Toshihiko FUJIOKA, Takashi TOKITA, Masaichi TAKINO, Hideki ...

1994 Volume 87 Issue 6 Pages 745-750
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.745

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This paper deals with an otitis media in children which was seen frequent in the Fukuchiyama region from 1951 to 1952. It was first reported by Dr. Yutaro Nishigaki in Fukuchiyama City and then observed by Dr. Masaich Takino of Gunze Hospital in Ayabe adjoining Fukuchiyama.
We examined 65 patients at Dr. Nishigaki's request and carried out mastoid operations on 13 ears of 11 patients. The clinical features of the disease were similar to the otitis media which is now called otitis media with effusion (OME). The age of the patients, otoscopic appearance, operative and histopathologic findings and results of bacteriological and virological examinations are described on the basis of Asai's paper which was read at the Annual Meeting of the Otorhinolaryngological Society of Japan in 1953.
In Japan, the incidence of OME has increased since the 1970's, and there are many clinical and etiological problems. We hope that the this information about numerous cases of OME in the early 1950's will provide significant insight into the pathogenesis of the disease.

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Middle Ear Foreign Body of Ear Molding Material

Shinsuke ITO, Naomi UCHIDA, Masao TAKETOMI, Hirofumi JOHNO

1994 Volume 87 Issue 6 Pages 751-754
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.751

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A foreign body was found in the left middle ear of a 64-year-old woman during tympanoplasty- I surgery. No abnormalities were found in the external canal or inner ear. Element analysis by X-ray microanalyzer and infrared spectrum revealed that the foreign body consisted of polymethyl metacrylate beads (a resin) surrounded with a little fibrous tissue. Molding material had been instilled into the left external ear canal 4 months earlier when she was fitted for a hearing aid because of moderate bilateral deafness. The molding material had exactly the same element composition as the foreign body. So it appeared that the plastic material had flowed into the middle ear through a small hole in the ear drum to form the foreign body of resin. The resin had probably caused marked unilateral otorrhea and severe hearing loss in the left ear. In the making of hearing aid molds, medical care and consultation by specialists is as necessary as when contact lenses are prescribed.

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Refractory Otitis Media with Effusion and Gholesteatoma

Akihiko FUJITA, Kyosuke KURATA, Haruo TAKAHASHI, Iwao HONJO, Iken GAN, ...

1994 Volume 87 Issue 6 Pages 755-759
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.755

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The relationship between refractory otitis media with effusion (OME) and acquired aural cholesteatoma was examined from the aspects of eustachian tube function and concurrent upper respiratory tract inflammatory conditions.
Eustachian tube function was compared in 106 ears with refractory OME which did not heal before the age of ten and 133 ears with cholesteatoma (attic type 85 ears, sinus type 48 ears). Abnormally high, normal and abnormally low tubal opening pressures were seen in 31%, 56% and 13% cases of refractory OME, respectively, and in 27%, 53% and 20% of those of cholesteatoma. The percentages of abnormal opening pressures were significantly higher than those seen in OME children younger than ten years of age. The sniff-test was positive in 24% and 33% of cases of refractory OME and of cholesteatoma, respectively, but in only 8% of children with OME. On the other hand, less than half of the patients with refractory OME or cholesteatoma had sinusitis significantly fewer than OME children. These results suggest a pathologic relationship between refractory OME and cholesteatoma.

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Serum ECP and Prophylaxis in Japanese Cedar Pollinosis

Taku HATTORI, Masashi KATO

1994 Volume 87 Issue 6 Pages 761-766
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.761

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Serum ECP values, in addition to subjective symptom scores, blood eosinophil counts and serum total IgE values, were examined for the objective evaluation of the prophylactic treatment of Japanese cedar pollinosis with ketotifen.
Subjective symptom scores were significantly and serum total IgE values were slightly elevated in the non-treated group during the pollen season. Serum ECP values were significantly elevated during the season with or without prophylactic treatment and were still elevated two weeks after the season.
We concluded that 1) prophylactic treatment of Japanese cedar pollinosis with ketotifen was effective, 2) serum ECP values remained elevated during and after the pollen season, and 3) serum ECP values are not related to subjective symptom.

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Criteria for Daily Forecasts of Airborne Cedar Pollen Counts with Type II Quantification

Shigehito MORI, Yasumasa TOKUDA, Yasuyuki TASAKA, Hitoshi SAITO, Mitsu ...

1994 Volume 87 Issue 6 Pages 767-772
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.767

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We analized data related to daily cedar pollen counts and meteorological factors for 53 days in the pollinosis season in 1991 by type IT quantification, a concept of multivariant analysis, and established criteria for the daily forecast of airborne cedar pollen counts.
This analysis makes it possible to introduce objectively factors such as weather or wind into the forecasts, and these criteria are useful throughout the pollinosis season.
These criteria were tested for 60 days in 1990 and 47 days in 1992, and good results were obtained (73.3% accuracy in 1990, 78.7% in 1992). Moreover, in the 1993 season forecasts of daily airborne pollen counts with the use of these criteria proved to be 73.8% accurate.

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Clinical Study of YAMIK Sinus Catheter

Nobuo KUBO, Akihiko NAKAMURA, Chiyonori INO, Tadami KUMAZAWA, Toshio Y ...

1994 Volume 87 Issue 6 Pages 773-782
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.773

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The YAMIK sinus catheter, which was developed in Russia, is less difficult to use and causes fewer complications than the Proetz displacement method, the standard physical therapy procedure for chronic sinusitis. This method was used once a week for 3 consecutive weeks to treat 132 patients with chronic sinusitis. The only complication was slight nasal bleeding found during receiving negative pressure. An evaluation of subjective symptoms and objective findings showed that headache and nasal secretion were significantly diminished during and after treatment. Its remarkable effectiveness in reducing sinus pressure supports the “hydrops ex vacuo” theory as the mechanism of frontal sinusitis.

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Two Gases of Metastatic Malignant Tumor of Parotid Gland Lymph Node

Yuji Imate, Hirotaka Hara, Masahiro Takahashi, Takeshi Sagara, Junji N ...

1994 Volume 87 Issue 6 Pages 783-787
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.783

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We treated two patients with metastatic parotid gland tumor, one with trichilemmal carcinoma which had metastasized from the preauricular area to the paraglandular lymph nodes and one with retinoblastoma which had metastasized to the intraglandular and paraglandular lymph nodes.
We discuss the differential diagnosis of metastatic lesions to the parotid gland and the surgical treatment, especially in regard to the management of parotidectomy, to neck dissection and to sacrifice of the facial nerve.

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High-Resolution Sonography in Diagnosis of Pleomorphic Adenoma of Salivary Glands

Yuji KANO, Hiroyuki KAKUTA, Hitoshi HIRATSUKA

1994 Volume 87 Issue 6 Pages 789-795
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.789

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Ten MHz high-resolution sonography with direct probe scanning and probe scanning with a low-attenuating ultrasonic acoustic coupler were compared in 30 patients with pleomorphic adenoma. 1) The margins of the adenoma were clearly delineated with probe scanning with the coupler in all cases. 2) Decreased internal echogenicity was obtained in 73.3% of the pleomorphic adenomas, while internal echogenicity was the same in 26.7%.
3) Large cystic degenerations were demonstrated in 26.7% of the adenomas and small cystic degenerations in 26.7%. 4) Calcifications (small areas of high echogenicity) were disclosed in 43.3% of the adenomas. 5) Enhanced posterior echoes were demonstrated in all cases. 6) Decreased lateral shadows were demonstrated in those with decreased internal echogenicity (73.3%), while 26.7% of those with the same internal echogenicity showed no change in the lateral shadow.

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Benign Lymphoepithelial Lesion in the Parotid Gland; A Report of Two Cases

Yoshinari HIRATA, Tetsuo KOZAWA, Shingo MURAKAMI, Eiji YUMOTO

1994 Volume 87 Issue 6 Pages 797-802
Published: June 01, 1994
Released on J-STAGE: December 12, 2011

DOIhttps://doi.org/10.5631/jibirin.87.797

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Two atypical benign lymphoepithelial lesions in the parotid gland and cervical lymphadenopathy are reported. The nonhomogeneity of the tumor echogram and the swollen neck lymph nodes strongly suggested malignancy of the parotid gland. Pathological findings of the resected parotid lesions revealed atrophy of the glandular parenchyma and epimyoepithelial islands, diagnosed as “benign lymphoepithelial lesion”. The neck lymph nodes in case 1 were reactive hyperplastic lesions and in case 2 granulomatous and/or tuberculous lymphadenitis. No lymphoepithelial lesion was found in the neck lymph nodes. The relationship between the original parotid lesion and neck lymphadenopathy was not clear. Benign lymphoepithelial lesion could be approvable entity in some parotid masses even when accompanied by cervical lymphadenopathy.

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Comparison of Apnea and Apnea-Hypopnea Indexes in Persons with Breathing Disorders during Sleep

Natsuki MORISHIMA, Tadao NISHIMURA, Kiyokazu HASEGAWA, Yoshiyuki URUMA ...

1994 Volume 87 Issue 6 Pages 803-808
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.803

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The Apnea Index (AI) has been used in the past in the diagnosis of disordered breathing during sleep, but today Apnea-Hypopnea Index (AHI) is used to revual in detail the respiratory condition during sleep. We compared the AI and the AHI in 54 adults and 34 children who were operated on and whose sleep was then monitored.
More children than adults had a difference between AI and AHI. There was no difference between AI and AHI in those adults with an AI<20, but there was a difference in those with an AI>20. In children there was a difference between AT and AHI in those with an AI>5, but no difference in those with an AI<5.
The difference between AI and AHI increased as the AI rose in both adults and children. There were no differences between AI and AHI in relation to the outcome of surgery.

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Clinical Anatomy of the Parapharyngeal Space

-Study by Imaging of CT and MRI-

Shinichi KAWABORI, Takuya ARAKAWA, Ken TANAKA, Satoshi NONAKA

1994 Volume 87 Issue 6 Pages 809-815
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.809

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The parapharyngeal region of one cadaver was dissected, and enhanced CT scans and T1 weighted MRI of three normal persons from the skull base to the hyoid bone were performed. Three-dimensional reconstruction of the parapharyngeal space was carried out on the basis of CT images. We examined the relationship between the parapharyngeal space which consisted mainly of fatty tissue and the surrounding structures. Our findings seem to be useful for the understanding of the shape and location of the parapharyngeal space and the clinical understanding of parapharyngeal space tumors. We discussed the differences between the parapharyngeal space and the carotid space with the 9th-12th cranial nerves, sympathetic chain, carotid artery and jugular vein.

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Intrathyroid Thymoma; A Case Report

Koji MIYATA, Hiroyuki KITAMURA, Kenichi KANEKO, Ryo ASATO, Shigeru HIR ...

1994 Volume 87 Issue 6 Pages 817-820
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.817

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Intrathyroid thymoma is a rare tumor. A 55-year-old male visited our hospital for acute laryngitis. We noted a thyroid tumor incidentally. The tumor, located in left lobe, was resected, and the histopathological diagnosis was intrathyroid thymoma. Postoperative radiation was performed.

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Elastofibroma of the Sternocleidomastoid Muscle

Yoshimi MIYAJIMA, Shinzo TANAKA, Katsuya YAMAGUCHI, Ryuji NAKANO, Shoi ...

1994 Volume 87 Issue 6 Pages 821-824
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.821

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A rare case of elastofibroma of a sternocleidomastoid muscle is reported. The patient was a 71-year-old male who had had a swelling on the left side of his neck for 5 years and hypokinesia of the left upper arm. He was born in Ohmuta city, Kyushu, Japan and had been a fisherman for 40 years. The tumor was elastic hard, 15 x 6 cm in size and located in the left sternocleidomastoid muscle. Elastic material and degenerative striated muscle were seen in the biopsy specimen. After resection of the left sternocleidomastoid muscle, including the tumor, his complains disappeared. The patient had no evidence of disease 7 months after surgery. The etiologic factors of this tumor were inferred to be constitutional predisposition and reactive hyperplasia.

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Tracheal Neurinoma; A Case Report

Koichi OKI, Yuzo YAMAMOTO, Kazuo MAKIMOTO, Hiroaki TAKAHASHI, Itoji SH ...

1994 Volume 87 Issue 6 Pages 825-830
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.825

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Primary benign tumors in the trachea are rare, and neurinoma is extremely rare. Symptoms of airway obstruction occur as the tumor grows. However, since the tumor grows slowly and is rarely seen, it is misdiagnosed as a pulmonary disease, and treatment is continued by internists. Not until symptoms became prominent is this disease identified. We report here a case of tracheal neurinoma.
An 57-year-old woman complained of dyspnea. Bronchial asthma was diagnosed in the Department of Internal Medicine, where she received treatment but with no improvement. Hoarseness then occurred. A CT scan revealed a tumor in the trachea, so she was referred to this department. At her first visit, fiberscopic examination revealed a light yellow, hemispheric tumor, with a smooth surface under the glottis. A CT scan confirmed that the tumor originated from the posterior wall of the trachea. Because of severe dyspnea, tracheostomy was performed and a biopsy done. The microscopic diagnosis was neurinoma. Intraluminal excision of the tumor was performed. The tumor was about 2cm long and extended from tracheal ring I to ring N along the posterior wall. To detach the tumor, a median incision was made on the mucous membrane of the posterior wall of the trachea. No adhesions were encountered between the tumor and the mucous membrane of the trachea. The tumor with its capsule was easily excised by submucous detachement, and the anterior wall of the trachea was sutured.

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Effects of Bifemelane Hydrochloride on the Outer Hair Cells

Katsuhisa IKEDA, Tomonori TAKASAKA

1994 Volume 87 Issue 6 Pages 831-834
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.831

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The intracellular free calcium concentration ([Ca²⁺]i) in the cochlear outer hair cells (OHC) of the guinea pig was measured with a microfluorimetric imaging technique and the effects of free radicals and bifemelane hydrochloride were investigated. The application of hypoxanthine (HX) plus xanthine oxidase (XO) to the OHC resulted in an increase in [Ca²⁺]i. in the presence of external Ca²⁺. Elimination of external Ca²⁺ did not cause an increase in [Ca²⁺]i . The elevation of [Ca²⁺]i induced by HX-XO was reduced by the addition of superoxide dismutase. These findings indicate that superoxide anions generated in the OHC increase Ca²⁺ influx across the membrane. Administration of bifemelane hydrochloride significantly inhibited the increase in [Ca²⁺]i induced by HX-XO, suggesting that bifemelane has a therapeutic effect on pathological events in the OHC.

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Clinical Effect of Celeport^® in the Treatment of Sensorineural Hearing Loss and Tinnitus

Ryuji KIYOTA, Taijirou IMAKIIRE, Souiku WATANABE, Yasuo IWABUCHI, Fumi ...

1994 Volume 87 Issue 6 Pages 835-844
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.835

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The therapeutic effect of Celeport^® was studied in 35 patients with chronic sensorineural hearing loss. Their ages ranged from 41 to 79 years (average 65.2). The oral dose of Celeport^® was 150 mg daily. The severity of hearing loss and of tinnitus was recorded before and the end of treatment.
The medication was effective in improving hearing or reducing tinnitus in 51.4% of the patients. In 35.4% of 65 ears hearing improved. The average hearing level, maximum discrimination level in speech articulation test and threshold of interaural time discrimination in directional hearing were improved. In the patients whose hearing was improved subjectively, the average hearing level and threshold of interaural time discrimination were improved significantly (p<0.001 and p<0.05). However, there was no significant difference in maximum discrimination level before and after of the medication. These results indicate that this drug can improve neural function in the brainstem.
This drug reduced tinnitus in 40.0% of the 25 patients with hearing loss plus tinnitus. It was interesting that the medication caused no reduction of pure tone type tinnitus. There was a significant difference in efficacy between band noise type tinnitus and pure tone type tinnitus (p=0.0035).
A side effect, erosion of the oral mucosa was detected in one patient, who kept the drug in his mouth for several minutes.
Celeport^® is considered to be useful in the treatment of chronic hearing loss and/or tinnitus due to neural dysfunction in the brainstem.

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Effect of Nicergoline on Vertigo and Tinnitus

Takeshi AKISADA, Yozo ORITA, Yukihiro SATO, Toru HANDA, Kazuko YADA, A ...

1994 Volume 87 Issue 6 Pages 845-855
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.845

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Nicergoline is a synthetic alkaloid with many effects on the CNS. Forty six patients suffering from vertigo and tinnitus were treated with nicergoline in a dose of 15 mg/day for four or eight weeks. The efficacy of the drug in the reduction of vertigo was marked improvement in 11.1%, marked or moderate improvement in 62.5% and slight to marked improvement in 88.9% at four weeks. At eight weeks there was marked improvement in 6.7%, marked or moderate improvement in 66.7% and slight to marked improvement in 100%. At four weeks tinnitus was markedly reduced in 5%, markedly or moderately reduced in 20.0% and slightly to markedly reduced in 65.0%. At eight weeks the corresponding figures were 7.9%, 61.5% and 92.3%. Only one patient complained of some side effect. The results suggest that nicergoline is a safe and clinically useful drug for the treatment of vertigo or tinnitus.

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Prophylactic and Therapeutic Effect of Ketotifen Orally and by Aqueous Nasal Spray for Japanese Cedar Pollinosis

Keisuke UESUGI, Hitoshi MIHO, Tatsuya TORIGOE, Isamu TAKEYAMA

1994 Volume 87 Issue 6 Pages 857-864
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.857

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We studied the prophylactic and therapeutic effect of ketotifen in patients with Japanese cedar pollinosis.
We administratered ketotifen orally to patients before the beginning of the dispersion of pollen.
Ketotifen aqueous nasal spray (ketotifen-ANS) was administered to the poor-response groups in the prophylactic and therapeutic group.
In the assessment of the final overall prophylactic effect 48.8% of the patients examined during the season showed “marked” or “moderate” effectiveness.
The poor-response patients treated with ketotifen-ANS showed marked or moderate effectiveness in 83.2%. The therapeutic results were good in 59.3% of those treated after symptoms had started. Ketotifen-ANS was useful in both the poor-response and the therapeutic groups.
The only side effect was sleepiness 7 patients receiving oral ketotifen. No abnormality was observed in those treated with ketotifen-ANS.
Oral ketotifen and aqueous nasal spray ketotifen are considered to be excellent for the prophylaxis and therapy of Japanese cedar pollinosis.

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How to Graft a Fascia for Trympanic Membrane Reconstraction in Tympanoplasty

[in Japanese]

1994 Volume 87 Issue 6 Pages 866-867
Published: June 01, 1994
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.87.866

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